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Distance to emergency obstetric services and early neonatal mortality in E thiopia
Author(s) -
McKin Britt,
Harper Sam,
Kaufman Jay S.,
Abdullah Muna
Publication year - 2014
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12323
Subject(s) - medicine , logistic regression , health facility , emergency medical services , infant mortality , medical emergency , pediatrics , demography , health services , environmental health , population , sociology
Objectives To assess the effect of distance to emergency obstetric and newborn care ( E m ONC ) services on early neonatal mortality in rural E thiopia and examine whether proximity to services contributes to socio‐economic inequalities in early neonatal mortality. Methods We linked data from the 2011 E thiopian D emographic and H ealth S urvey with facility data from the 2008 E thiopian N ational E m ONC N eeds A ssessment based on geographical coordinates collected in both surveys. Health facilities were classified based on the performance of nine E m ONC signal functions (e.g. neonatal resuscitation, C aesarean section). We used multivariable logistic regression to assess the relationship between distance to services and early neonatal mortality. A decomposition approach was used to quantify the relative contributions of distance to E m ONC services and other determinants to overall and socio‐economic inequality in early neonatal mortality. Results In general, closer proximity to E m ONC services and higher level of care were associated with lower early neonatal mortality. Living more than 80 km from the nearest comprehensive E m ONC facility able to perform all nine signal functions compared to living within 10 km was associated with an increase of 14.4 early neonatal deaths per 1000 live births (95% CI : 0.1, 28.7). Closer proximity to a substandard E m ONC facility compared with no facility was not associated with lower early neonatal mortality. Distance to E m ONC services was an important determinant of early neonatal mortality, although it did not make a significant contribution to explaining socio‐economic inequality. Conclusions Our results suggest that recent initiatives by the E thiopian government to improve geographical access to E m ONC services have the potential to reduce early neonatal mortality but may not affect inequalities.